62-year-old man presents for evaluation of a persistent “rash” on his trunk that has been present for several months. He reports the gradual development of brown discoloration that has not improved despite regular washing with soap and water. The lesions are asymptomatic, without associated itching, pain, or bleeding. He denies any recent changes in personal hygiene products or medications and denies systemic symptoms. His medical history is unremarkable.
On examination, there are yellow-brown, thin, rough plaques with a “dirty” appearance on the chest and back. The lesions are non-tender and lack surrounding erythema, scale, or signs of inflammation. No excoriations, vesicles, or purpura are noted.
Gentle swabbing of the affected areas with isopropyl alcohol pads results in immediate removal of the plaques, revealing normal underlying skin.
What is the most likely diagnosis?
A- Confluent and reticulated papillomatosis (CARP)
B- Dermatosis neglecta
C- Pityriasis versicolor
D- Terra firma-forme dermatosis
